Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220
SPLANCHNIC HAEMODYNAMICS AND INTESTINAL VASCULARITY IN ILEAL CROHN’S DISEASE. AN IN VIVO EVALUATION USING DOPPLER ULTRASOUND, CONTRAST-ENHANCED ULTRASOUND AND BIOCHEMICAL PARAMETERS E. Bolzacchini ∗ ,1 , J. Maier 2 , A. Dell’Era 2 , F. Furfaro 1 , A. Cassinotti 1 , S. Ardizzone 1 , R. De Franchis 1 , G. Maconi 1 1 Gastrointestinal 2 Department
Unit - Luigi Sacco University Hospital, Milan, Italy; of Clinical Sciences - L.Sacco University Hospital, Milan, Italy
Background and aim: Crohn’s disease (CD) is characterized by inﬂammation, angiogenesis and microvascular remodeling of affected bowel. These features have been associated with damage to mesenteric vascular blood supply and with impaired splanchnic haemodynamics (SH). We evaluated the SH and microvascular changes in response to a standard meal in patients with ileal CD. Material and methods: 16 pts with ileal CD (mean age 39) and 10 healthy controls were included. Doppler ultrasound (US) of portal vein and superior mesenteric artery was used to assess quantitative and semiquantitative indexes (ﬂow volume, resistance and pulsatility indexes). Vascular perfusion of terminal ileum was assessed by color-Doppler US (resistance index of arteriolar bed of bowel wall) and real-time contrast-enhanced US (CEUS), after the injection of 2.4 ml of sulfur hexaﬂuoride-ﬁlled microbubbles (SonoVue, Bracco, Milan, Italy) and vascularity was quantiﬁed (Q-ontrast, Bracco, Milan) using different kinetic parameters of perfusion. Inﬂammation, angiogenesis and endothelial function were evaluated by measuring VEGF, TNF-a and NO. All measurements were performed before and 30 min after a meal (Resource Energy - Nestlè, 300 kcal). Statistical analysis was performed using Wilcoxon and Spearman’s rank correlation tests. Results: Basal and postprandial SH and CEUS parameters did not differ between CD patients and controls, whilst resistance index of arteriolar bed, detectable only in CD patients, showed a signiﬁcant reduction after meal. NO and TNF-a signiﬁcantly reduced after meal only in CD patients. A signiﬁcant correlation was found between CEUS parameters of vascular perfusion, and VEGF before the meal (r= 0.63-0.71; p<0.05).Furthermore, we found a signiﬁcant correlation between splanchnic blood ﬂow and CEUS parameters of vascular perfusion during fasting (r= 0.66-0.79; p<0.05), but not in the postprandial period. Conclusions: In ileal CD patients, splanchnic blood ﬂow is correlated with vascular perfusion of the intestinal wall, which is related to VEGF. This is evident during fasting, not in the post-prandial period, where other vasoactive factors are probably involved.
P.05.21 CLINICAL COURSE OF PERIANAL FISTULAS IN CROHN’S DISEASE: A RETROSPECTIVE STUDY L. Alessandroni 1 , L.G. Papparella ∗ ,1 , M.C. Addarii 1 , I. Guadagni 1 , C. Papi 2 , A. Khon 1 1 Azienda
Ospedaliera San Camillo Forlanini, Roma, Italy; 2 Azienda Ospedalira San Filippo Neri, Roma, Italy Background and aim: Perianal ﬁstulas are frequent complications of Crohn’s disease (CD) that can result in signiﬁcant morbidity, reduced QoL and need for costly medical therapy. Despite the importance of this condition, little is known about long term outcome and risk for defunctioning stoma or proctectomy over time. The aim of the present study is to retrospectively determine the negative outcomes deﬁned as deﬁnitive damage (anorectal stenosis/faecal incontinence) and defunctioning stoma or proctectomy for these patients. Material and methods: We selected all CD patients with perianal ﬁstulas that were diagnosed and classify with examination under anesthesia at the Surgical Department of the San Camillo Forlanini Hospital from 1980 to 2010. Recto-vaginal and recto-urethral ﬁstulas were excluded. The follow-up was calculated from diagnosis to appearance of a negative outcome or to the end of follow-up. Patients were divided in 3 cohorts according to the time of diagnosis (A: 1980-1989, B: 1990-1999, C: 2000-2010).
Results: 114 patients (41.2% females, median age 49 yrs [range 18-91]) with perianal ﬁstulas were analyzed; 19 (17%) had ileal disease, 35 (30%) had colonic and 60 (53%) ileocolonic involvement. Complex ﬁstulas were diagnosed in 97 (85%) patients (86 transphincteric, 5 suprasphincteric, 6 extrasphincteric), 17 (15%) had simple ﬁstulas (11 superﬁcial, 6 intersphincteric), 75 (66%) had an associated abscess and 77 (67%) rectal involvement. The median follow up was 96 months (range 0-240); within this period 84% underwent 1 surgical procedure, 64%, 47%, 23% and 9% underwent respectively 2, 3, 4 and 5 different surgical procedures. The cumulative probability of course free from negative outcome was 0.69 at 20 years, not inﬂuenced by the type of ﬁstula, but signiﬁcantly higher when the rectum was involved (0.55, p< 0.001). The cumulative probability of proctectomy or stoma was not signiﬁcantly different for the three cohorts (A, B, C) of patients. Conclusions: Our results suggest that, in the long term, the risk of deﬁnitive damage, proctectomy or stoma is high (31%), apparently not inﬂuenced by the type of ﬁstula, but by the rectal localization of the disease. Despite the introduction of novel biological treatments over the last decade, the cumulative probability of negative outcomes in the long term did not change signiﬁcantly.
P.05.22 INFLAMMATORY BOWEL DISEASES AND PERICARDITIS G. Inserra ∗ ,1 , G. La Ferrera 1 , L. Samperi 1 , L. Zanoli 1 , M.R. Cannavò 1 , I. Monte 2 1 Medicina
Interna, Azienda Policlinico, Catania, Italy; 2 Cardiologia, Azienda Policlinico, Catania, Italy Background and aim: Extra-intestinal manifestations in IBD sometimes involve serous layers such as peritoneum, pleura and pericardium. In literature only few cases of pericarditis and pleuro-pericarditis among IBD pts have been reported. However their prevalence and etiopathogenesis are not known. We evaluated, with echocardiography, the presence of cardiac involvement in a group of IBD pts, and described their clinical characteristics. Material and methods: From January to October 2010, performing a study on prevalence of early atherosclerosis among IBD pts, we evaluated 19 pts (10M, 9F; 8 CD, 11 UC; 21-54 years), asymptomatic and with negative anamnesis for cardiopathy. All underwent ECG and Echocardiogram, relieving M-Mode, Doppler and Color-Doppler parameters (diameter and parietal thickness of left ventricular, ejection fraction, atrial volume left, MAPSE, TAPSE and transmitral ﬂow velocity, pericardium evaluation). Echocardiogram was assessed positive for pericarditis in presence of a detachment of pericardial layers. Results: All pts had normal ECG and indexes of cardiac function between normal range. 6/19 pts showed thickening of pericardial layer (5 with detachment = 2 mm, 1 with detachment of 3 mm). The clinical characteristics of pts are resumed in Table 1. No one was submitted to invasive exams or therapeutic treatments for pericarditis because asymptomatic and no evident cardiac alteration appeared at 3 and at 6 months of follow-up.
Table 1 Males Females Mean age (years) Crohn RCU Azathioprine, 6-MP Anti-TNFα 5-ASA Mean time of disease duration (years) Clinical remission
No Pericarditis (n=13)
3 3 37.3 2 4 0 2 3 6.8 4
6 7 31.1 6 7 4 2 7 6.1 7
Conclusions: To date pericarditis in IBD is supposed to be a rare and casual event. It is not evident wether it belongs to extra-intestinal manifestations or is a complication linked to infective factors. In our group of pts pericarditis was diagnosed in 32%. Our ﬁndings on a little sample suggest that pericarditis could be relatively common in IBD and that has a very benign course. More studies on a larger population will be necessary to know the exact prevalence and the most important risk factors associated.